Elevated uric acid and adenosine triphosphate concentrations in bronchoalveolar lavage fluid of eosinophilic pneumonia

Publication date: Available online 10 July 2017
Source:Allergology International
Author(s): Takehito Kobayashi, Kazuyuki Nakagome, Toru Noguchi, Kiyoko Kobayashi, Yutaka Ueda, Tomoyuki Soma, Kenji Ikebuchi, Hidetomo Nakamoto, Makoto Nagata
BackgroundRecent evidence has suggested that the innate immune response may play a role in the development of eosinophilic airway inflammation. We previously reported that uric acid (UA) and adenosine triphosphate (ATP), two important damage-associated molecular pattern molecules (DAMPs), activate eosinophil functions, suggesting that these molecules may be involved in the development of eosinophilic airway inflammation. The objective of this study was to measure the concentrations of DAMPs including UA and ATP in the bronchoalveolar lavage fluid (BALF) of patients with eosinophilic pneumonia (EP).MethodsBAL was performed in patients with EP including acute and chronic eosinophilic pneumonia, and in patients with hypersensitivity pneumonia, and sarcoidosis. UA, ATP, and cytokine concentrations in the BALF were then measured.ResultsThe UA concentration was increased in the BALF of EP patients. UA concentrations correlated with eosinophil numbers, and with eosinophil-derived neurotoxin and interleukin (IL)-5 concentrations. Furthermore, the ATP concentration was increased in the BALF of EP patients and ATP concentrations correlated with UA concentrations. Moreover, IL-33 was increased in EP patients and IL-33 concentrations correlated with UA and ATP concentrations.ConclusionsThe UA and ATP concentration was increased in the BALF of EP patients. UA concentrations correlated with eosinophil numbers, and with ATP and IL-33 concentrations. Our findings suggest that DAMPs such as UA and ATP play a role in the pathogenesis of EP.



http://ift.tt/2v6tkJk

A prospective study of chin bone graft harvesting for unilateral maxillary alveolar cleft during mixed dentition

Publication date: Available online 10 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): AliReza Shirzadeh, Amin Rahpeyma, Saeedeh khajehahmadi
BackgroundThe chin is a common donor site for alveolar cleft bone grafting. The amount of bone available at this site may be limited, as conservative harvesting with mixed dentition must consider the incisive nerve, the unerupted mandibular canine, and the integrity of the inferior mandibular border.Materials and methodsPatients with nonsyndromic unilateral alveolar cleft in the mixed dentition stage were selected for this study. The volume of the bone obtained from the mandibular symphysis (symphysis menti), degree of alteration in lower-lip sensation, anterior tooth vitality, remaining bone in the alveolar cleft, and bone defects at the donor site 1 year after surgery were evaluated.ResultsEighteen patients enrolled in this study. Mean volume of the bone harvested from the symphysis was 2.1 mL (range, 1.6 to 2.3 mL). For all cases, the bone volume harvested from the symphysis was not enough to fill the alveolar cleft defect, and allograft had to be added to completely fill the cleft. Allograft was admixed in the range of 0.5 to 1 mL with autogenous bone harvested from the mandible. Lower-lip sensation and vitality of the anterior teeth of the mandible were within a normal range one year after the operation in all cases. Fourteen of 18 patients (77.8%) had either normal bone height or bone height at least three-fourths of expected height in the grafted alveolar cleft after 1 year; only 10% of the defect remained in the mandible.ConclusionThe amount of bone yielded by conservative monocortical bone harvest from the mandibular symphysis during the mixed dentition stage for unilateral alveolar cleft bone grafting is not sufficient in volume and should be mixed with allograft. However, donor site morbidity is low with this approach.



http://ift.tt/2tHTX7K

Influence of external cooling on the femtosecond laser ablation of dentin

Abstract

In the present work, the influence of external cooling on the temperature rise in the tooth pulpal chamber during femtosecond laser ablation was investigated. The influence of the cooling method on the morphology and constitution of the laser-treated surfaces was studied as well. The ablation experiments were performed on dentin specimens using an Yb:KYW chirped-pulse-regenerative amplification laser system (560 fs, 1030 nm). Cavities were created by scanning the specimens at a velocity of 5 mm/s while pulsing the stationary laser beam at 1 kHz and with fluences in the range of 2–14 J/cm². The experiments were performed in air and with surface cooling by a lateral air jet and by a combination of an air jet and water irrigation. The temperature in the pulpal chamber of the tooth was measured during the laser experiments. The ablation surfaces were characterized by scanning electron microscopy (SEM) and Fourier transform infrared (FTIR) spectroscopy. The temperature rise reached 17.5 °C for the treatments performed with 14 J/cm² and without cooling, which was reduced to 10.8 ± 1.0 and 6.6 ± 2.3 °C with forced air cooling and water cooling, respectively, without significant reduction of the ablation rate. The ablation surfaces were covered by ablation debris and resolidified droplets containing mainly amorphous calcium phosphate, but the amount of redeposited debris was much lower for the water-cooled specimens. The redeposited debris could be removed by ultrasonication, revealing that the structure and constitution of the tissue remained essentially unaltered. The present results show that water cooling is mandatory for the femtosecond laser treatment of dentin, in particular, when high fluences and high pulse repetition rates are used to achieve high material removal rates.

http://ift.tt/2sZ4w9l

High-flow paediatric mandibular arteriovenous malformations: case reports and a review of current management

High-flow vascular malformations in the paediatric population are potentially life-threatening and are challenging to treat. This paper describes the management of three cases of mandibular arteriovenous malformations and reviews the contemporary management options for these serious lesions.

http://ift.tt/2uKDM9Z

Successful pregnancy after mucinous cystic neoplasm with invasive carcinoma of the pancreas in a patient with polycystic ovarian syndrome: a case report

The incidence of invasive cancer within a mucinous cystic neoplasm of the pancreas varies between 6 and 36%. Polycystic ovarian syndrome is a disorder characterized by hyperandrogenism and anovulatory infertil...

http://ift.tt/2sJNtUI

Is peanut causing food allergy in Cuba? Preliminary assessment of allergic sensitization and IgE specificity profile to peanut allergens in Cuban allergic patients

Peanut allergy is increasing at an alarming pace in developed countries. Peanut (Arachis hypogaea) is a common food in Cuba. Nevertheless, reported values of sensitization and symptom severity are usually low. As...

http://ift.tt/2u7mNAu

Unusual osteolytic lesion of the jaw

Publication date: Available online 10 July 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Karine Duarte da Silva, Isadora Luana Flores, Adriana Etges, Ana Carolina Uchoa Vasconcelos, Ricardo Alves Mesquita, Ana Paula Neutzling Gomes, Sandra Beatriz Chaves Tarquinio




http://ift.tt/2t7pjms

Advances in midface reconstruction: beyond the reconstructive ladder.

Purpose of review: This article reviews the anatomy and function of the midface, defect classifications and the breadth of common and novel reconstructive techniques including medical modeling, dental splints, and dental rehabilitation. Recent findings: Historically many classification systems for midface and maxillary defects exist but most defects are unique and an individualized approach is required. There has been an increased interest in using regional pedicled flaps with bone for reconstruction. Free flap reconstruction with the osteocutaneous radial forearm and fibula flap have been recently modified to increase the success of osseointegrated implants. Scapular free flap reconstruction has become increasingly popular because of the versatility, good bony contour match, and long pedicle length with the scapular tip flap. Dental splints are more cost effective than medical modeling and cutting guides but both techniques are complimentary in complex reconstruction. Summary: Midface reconstruction is a unique and challenging surgery demonstrated by the numerous classification systems and techniques available to reconstruct. Recent developments have further augmented these challenging reconstructions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2sXXMsu

The Safety and Accuracy of Surgical Navigation Technology in the Treatment of Lesions Involving the Skull Base.

Objective: As compared with the normal anatomy, structures of the skull base and its surroundings have been dramatically altered of the lesion near the skull base. How to remove the lesion at the skull base was mainly depending on surgeon's personal experience during past years. In this study, the authors explored the safety and accuracy of the surgical navigation system in resecting lesions near the skull base. Methods: The surgical cases consisted of 15 patients who underwent surgery involving the skull base with the using of surgical navigation technology. Five patients had adenoid cystic carcinoma at minor salivary glands of the palate extending to the skull base and 10 patients were suffered from bony ankylosis of temporomandibular joint. After the system converted patient's computed tomography scans into three-dimensional reconstructive images, preoperative planning and simulation of the operation process could be made by surgeons. During the operation, the virtual images were matched with the patient through individual registration. The system provided surgeon with feedback about the operation on the screen instantly with moving the navigated pointer. Results: The application of surgical navigation system was safe and reliable for resecting the ankylotic bone and identifying the extent of tumors resection near the skull base. No complications including cerebrospinal fluid leak, cranial nerve injuries, severe bleeding happened to those patients. Conclusions: Given the safety and accuracy of the surgical navigation system, surgery near the skull base appeared to be an ideal field for using with its complex anatomy. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2u6QPEN

Distraction of Fronto-Orbital Segment as a Nonvascularized Bone Graft in Craniosynostotic Patients.

Fronto-orbital advancement using distraction techniques involves the dura left attached to the osteotomized bone segment to avoid dead space formation and dural injury, whereas it is impossible to reshape the supraorbital bar and the frontal bone complex, when necessary. Our approach combines advantageous parts of conventional and distraction osteogenesis techniques as remodel and distract the supraorbital bar and frontal bone complex as a free bone graft. Twenty-seven patients either being syndromic and nonsyndromic craniosynostosis, with at least 3 years of follow-up were reviewed in this study. Mean age of the patients at the time of the operation was 23.44 +/- 18.42 months and mean operative time was 4.96 +/- 0.97 hours. Blood transfusion was required in all patients, with an average of 112.04 +/- 44.60 mL. Amount of the distraction ranged 10 to 30 mm, a mean of 17.26 +/- 4.71 mm for the right side and 18.15 +/- 4.69 mm for the left side. Mean duration of consolidation was 98.26 +/- 12.98 days and mean follow-up was 41.33 +/- 22.92 months. In this study, result of internal distraction of fronto-orbital segment as a nonvascularized bone graft in craniosynostotic patients is reviewed to emphasize the efficacy of the nonvascularized bone graft distraction in management of craniosynostosis. Graft distraction after fronto-orbital and cranial vault remodeling appears to be safe and effective approach in correcting severe craniosynostosis deformities especially necessitating asymmetrical advancement. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2v57iGx

Would Be Prophylactic Administrations of Low Concentration of Alendronate an Alternative for Improving the Craniofacial Bone Repair? A Preliminary Study Focused in the Period of Cellular Differentiation and Tissue Organization.

Background: Alendronate (ALN) is a nitrogen-bisphosphonate that may induce an anabolic effect on craniofacial bone repair when administrated in low doses. Based on this premise, this study analyzed the influence of prophylactic low doses of ALN on bone healing in defects created in rabbit mandible. Methods: A 5 x 2-mm diameter deep defect was created in the calvaria of 28 rabbits. Fourteen of these rabbits received previously 50 [mu]g/kg of 1% sodium ALN for 4 weeks, while the other rabbits received only 0.9% physiological saline solution (control). Animals were euthanized at 15 and 60 days postsurgery (n = 7), and the data were analyzed using histomorphometry and immunohistochemistry using the anti-CD34, bone morphogenetic protein -2 (BMP-2), and transforming growth factor (TGF)-[beta]1 antibodies. Results: On the 15th day postsurgery, the specimens that received previous treatment with ALN demonstrated large vascular lumen and intense positivity to CD34 either concentrated in endothelium or cells spread among the reparative tissue. These results coincided with intense positivity for BMP-2+ cells and TGF-[beta]1 that was concentrated in both cells and perivascular area. In contrast, the control group revealed scarce cells that exhibited CD34, BMP-2+, and the TGF-[beta]1 was restricted for perivascular area on well-formed granulation tissue. These patterns of immunohistochemical result, especially found on the 15th day of analysis, seem to be responsible for the development of larger quantities of bone matrix in the specimens that receive ALN on the 60th day postsurgery. Conclusion: These preliminary results showed that the prophylactic administration of low doses of ALN might be an alternative to craniofacial bone craniofacial bone repair because it increases the immunopositivity for TGF-[beta]1 and consequently improves the CD34+ and BMP-2+ cells on reparative sites. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2u6wajX

Effect of Spreader Graft on Nasal Functions in Septorhinoplasty Surgery.

Objective: The authors aimed to investigate the effect of spreader grafts on nasal function in septorhinoplasty (SRP). Methods: A prospective randomized double-blind study was conducted. Thirty patients who underwent SRP operation between October 2011 and January 2013 were divided into 2 equal groups randomly. Fifteen patients underwent SRP surgery without spreader graft technique (Group I) and 15 patients underwent SRP surgery with spreader grafts (Group II). Preoperative and postoperative evaluation included visual analog score (VAS) and acoustic rhinometry test. Results: Visual analog scores and acoustic rhinometry measurements of Group I and Group II patients were compared. Statistically significant difference was found for VAS scores of both the sides of the nasal cavity (both before and after topical decongestion) (P 0.05). On acoustic rhinometry test the difference was statistically significant for minimal cross-sectional area (MCA) and volumetric values (VOL)-MCA1, MCA2, VOL1, VOL2 values on the left side of the nasal cavity (both before and after topical decongestion) (P 0.05). Conclusions: Performing spreader graft technique in SRP surgery can prevent the narrowing of the internal nasal valve area after surgery and maintain adequate airway for respiration. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubncCP

Modified Medial Ramus Retractor to Facilitate Horizontal Osteotomy During Sagittal Split Ramus Osteotomy Procedure.

Introducing a horizontal osteotomy is the first and a critical step in sagittal split ramus osteotomy procedure. Identification of the lingula and medial displacement of the vital structures entering the inferior alveolar foramen are of paramount importance in ensuring a risk-free placement of the medial cut with bur or a saw. Quite often, identification of lingula and retrolingular fossa can be an arduous task owing to the thickness of the internal oblique ridge. Hence, placement of horizontal osteotomy depends on the experience of the operator. Here, the authors describe a simple, low profile instrument that aids in the identification of the lingula as well as provide a posterior stop for horizontal osteotomy during the sagittal split ramus osteotomy procedure. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2uKzteI

"Brighter Hours Will Come": The Signet Ring of Florence Nightingale.

No abstract available

http://ift.tt/2ubI6SD

Reconstruction of Zygomaticomaxillary Buttress With Mandibular Ramus Bone Graft in Atrophic Maxillary Fracture.

No abstract available

http://ift.tt/2uKCOdB

Acquired Adult Onset Cyclic Esotropia in Patients With Myopic Strabismus Fixus and Intraocular Lens Implantation.

Purpose/Background: Cyclic esotropia is a rare condition that mostly occurs in children, characterized by patterns of straight and strabismic days with a regular cycle of 24 to 96 hours. In this report, 2 patients of cyclic esotropia in adults who showed a regular 48-hour cycle of mild deviation on 1 day followed by a more severe deviation on the second day are presented. Methods: Clinical reports, clinical features, imaging findings, and surgical outcomes are presented. Results: In patient 1, a 42-year-old male with high myopia was diagnosed with progressive esotropia for 2 years. A medial and lateral rectus (LR) recession/resection was performed 9 months before. On day 1 after this surgery, a relatively mild esotropia was present which developed into a severe esotropia on day 2. Being diagnosed as cyclic esotropia with myopic strabismus fixus, he underwent a 4 mm re-recession of the medial rectus combined with a half-Jensen procedure in his right eye. After the second surgery, the cyclic pattern was no longer present. In patient 2, a 39-year-old female with high myopia had concomitant esotropia for 20 years. At 6 months following bilateral intraocular lens implantation for her high myopia, she demonstrated a cyclic strabismus. On day 1, a 25 prism dioptres esotropia was present, which increased to a 45 prism diopters esotropia on day 2. A 4 mm recession of the medial rectus and 6 mm resection of the LR was performed in her left eye. After surgery, the cyclic pattern disappeared. Conclusions: Cyclic esotropia can occur in adults with myopic strabismus fixus subjected to horizontal strabismus surgery and with concomitant strabismus following intraocular lens implantation for high myopia. Their cyclic strabismus consisted of a mild squint on day 1 which increased in severity on day 2. The extent of surgery required for correction was based upon the "severe esotropia" experienced on day 2 and resulted in an excellent therapeutic outcome. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubvA5i

The Effect of External Approach Septoplasty on Olfactory Function.

Objective: Septal deviation-induced nasal obstruction is frequently accompanied by hyposmia. The aim of this study was to evaluate the effect of external approach septoplasty on olfactory function. Methods: Thirty patients (23 males, 7 females) who had external approach septoplasty were included in the study. The age interval was 18 to 60 years (mean 33+/-12 years). All subjects had olfactory function and acoustic rhinometry tests in both the pre- and postoperative periods (mean interval 6 weeks +/- 3 weeks). Olfactory function was determined by the "Sniffin Sticks" test. The minimum cross-sectional area from the nostril to 2.20 cm backward was referred to as MCA1, and the minimum cross-sectional area from 2.20 to 5.40 cm was referred to as MCA2, determined by acoustic rhinometry. Results: Olfactory threshold, discrimination, and identification function improved significantly after external approach septoplasty. A statistically significant difference was also detected between pre- and postoperative left MCA1 and left MCA2 of the nasal cavities. Postoperative hyposmic and anosmic patient improvement was statistically significant. Conclusion: External approach septoplasty has a beneficial effect on olfaction and this effect may be partly due to interactions between the increased perception of nasal air flow, as well as surgery-associated improvement in the internal nasal valve area. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2uKi5Xw

Presurgical Orthopedic Treatment Using Modified Nostril Retainers in Patients With Unilateral Cleft Lip With or Without Cleft Palate.

This study aimed to present a new technique for presurgical orthopedic treatment of patients with unilateral cleft lip with or without cleft palate (UCL+/-P) by means of modified nostril retainers manufactured using a special mold with soft acrylic or orthodontic acrylics material. Nasal molding with the modified nostril retainer is considerably effective and comfortable for the patient. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubmV2L

Reduction of Surgical Site Infections After Cranioplasty With Perioperative Bundle.

Background: Surgical site infections (SSI) are the most common complication after cranioplasty and it is associated with poor prognosis. The aim of this study was to identify the risk factors that triggered the development of SSI after cranioplasty and establish a new perioperative bundle and monitoring system to reduce SSI. Methods: A retrospective review of a database that included all cranioplasty patients from 2001 to 2007 was carried out to determine the prevalence of infection. A surveillance team was set up, which assessed the clinical practice and led to the development of a new perioperative bundle and supervision system. A prospective study between 2008 and 2014 was carried out to observe whether infection rates had changed and whether an active surveillance program can change clinical practice. Results: Retrospective period included 86 adult patients. The overall rate of infection was 10.5% (9 SSI in 86 patients). Age >=60 years (OR 1.05; 95% CI: 1.00-1.10; P = 0.04), smoking (OR 9.13; 95% CI: 1.65-50.60; P = 0.01), and duration of operation >=180 minutes (OR1.19; 95% CI: 1.06-1.34; P

http://ift.tt/2uKfFbe

Eagle Syndrome: a Follow-Up Examination of Four Patients After Surgical Treatment Via Cervical Approach.

Objective: Eagle syndrome is a rare pain syndrome caused by an elongated styloid apophysis or an ossified styloid ligament. It is characterized by a complex range of symptoms in head and neck region. The most effective treatment is surgical shortening of the styloid apophysis. The authors report of a follow-up examination of 4 patients after surgical treatment via cervical approach. Methods: Retrospectively reviewed hospital records of 5 patients (4 females and 1 male), aged from 26 to 59 years old (mean age = 45.5 years) who underwent surgical shortening of the styloid process via cervical approach. Further, a paper-based survey of 4 patients was conducted, including a clinical questionnaire and 4 visual analogue scales, consisting of questions regarding postoperative pain. Results: Period of follow-up ranged from 16 to 79 months (mean 53.75 months). All patients were asymptomatic at follow-up. None of the patients reported a visible scar or hypoesthesia in the affected area. The patients demonstrated low mean visual analogue scales for each item (facial pain: 0.6 +/- 1.2, foreign body sensation: 0.725 +/- 1.45, pain of throat and neck 1.35 +/- 1.58 and limitation of dietary habits: 0.75 +/- 1.5). None of the patients reported a resurgence of pain in the head and neck region so far. Conclusions: Surgical treatment via cervical approach appears to be an effective and safe option with low morbidity and mortality in the treatment of symptomatic Eagle syndrome of adults. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubfdps

Effect of Cervical Siphon of External and Internal Carotid Arteries.

Variant courses, configuration, and branching pattern of the external and internal carotid arteries, especially when curved in S-shape, are important for hemodynamic changes and clinical implications. Therefore, the aim of the study is to report abnormal cervical siphons observed in external and internal carotid arteries to explore clinical significance by review of literature and hemodynamic changes theoretically. The right common carotid artery bifurcated into external and internal carotid arteries at the level of the upper border of thyroid cartilage in a 70-year-old female cadaver. After bifurcation, the external carotid artery underwent severe tortuosity coursing through 5 bends at points A, B, C, D, and E from its origin to termination and 2 bends at A' and B' in internal carotid artery in the cervical region. The angles between inflow and out flow of the blood at the bends were measured and the change in velocity at each bend was computed for both arteries. Hemodynamic changes were calculated, compared and relevant clinical complications were theoretically correlated. The angles of 20[degrees], 30[degrees], 51[degrees], 52[degrees], 60[degrees], and 28[degrees], 48[degrees] were formed by 5 bends of external and 2 bends of internal carotid arteries, respectively. The curved courses of these arteries caused reduction in velocity/stasis, turbulence, and low shear stress. Such kinks might cause stroke, ischemia and mistaken for tumors and abscess in imagery leading to or otherwise producing iatrogenic repercussions. This study will be useful for anatomists, clinicians, and radiologists. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2uK98xa

Stepwise, Multi-Incisional, and Single-Stage Approach to Reshape Facial Contour After Large Cutaneous Lesion Resection.

Background: Removal of large facial benign cutaneous lesions remains challenging. Serial or complete excisions together with local flaps or expander-based reconstructions are required. However, those techniques are time-consuming and may contribute to poor cosmetic and functional outcomes. Objective: The authors describe the resection and reconstruction of large facial benign cutaneous lesions by using Stepwise, Multi-Incisional, and Single-Stage (SMISS) approach. Methods: The authors performed a retrospective review from all patients with large facial benign cutaneous lesions who underwent "SMISS" approach for reconstruction between September 2013 and December 2014. Results: The authors treated 47 patients (32 female and 15 male; mean age 23.5 years, range 9-50 years). Follow-up was for 12 months or longer. The mean length of major axis was 43.91 mm, minor axis 32.10 mm, and scar 66.91 mm. Good to excellent outcomes were achieved in all patients with a mean Vancouver scar scale score of 3.46 +/- 0.39 (Cronbach [alpha] = 0.890) and mean visual analog scale score of 8.02 +/- 0.69 (Cronbach [alpha] = 0.946). Limitations: This was a nonrandomized, unblinded clinical case series with a limited sample size. Conclusion: For the excision and reconstruction of large facial benign cutaneous lesions, "SMISS" technique can be considered as a suitable option, leading to excellent results and a high patient satisfaction. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubCCae

Giant Serpentine Middle Cerebral Artery Aneurysm.

Giant serpentine aneurysms are rare entity, which have unique presentations and distinct angiographic features, with poor prognosis if not treated. In this paper, a patient with a giant serpentine aneurysm originated from right middle cerebral artery was reported. A 38-year-old woman suffered from progressively headache and vision declined. The computed tomography and magnetic resonance image revealed a partially calcified, large mass (approximately 80 x 70 x 60 mm sized) in the right frontal-temple lobe. On computed tomography angiography, an unruptured, giant, partially thrombosed, serpentine aneurysm was confirmed. After treatment by craniotomy, the patient was rehabilitation. Operation is an effective method for the treatment of giant serpentine aneurysms. In addition, cerebral angiography and balloon test occlusion are the crucial way of preoperative assessment. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2uKiWHs

An Unusual Bullet Trajectory: Entered Through the Face and Ended Up in the Neck.

The authors describe a case of gunshot injury in a 26-year-old male patient with an unusual bullet trajectory. The bullet had an entry hole just near the right lateral alar cartilage of the nose, and the trajectory descended through the left side of the neck by route of the hard palate, soft palate, and posterior pharyngeal wall, respectively. Surgical removal of the bullet was achieved with neck exploration. Gunshot injuries of the head and neck necessitate a thorough clinical and radiological evaluation due to the possibility of an unusual bullet trajectory. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ub2tzb

Role of Notch Signaling in the Physiological Patterning of Posterofrontal and Sagittal Cranial Sutures.

Background: The mutations in a Notch signaling ligand, jagged 1, are associated with unilateral coronal craniosynostosis in humans. However, the underlying mechanisms of Notch signaling in cranial suture biology still remain unclear. Methods: The temporal and spatial patterns of Notch signaling expression were examined in the posterofrontal and sagittal sutures of Sprague-Dawley rats by real-time quantitative reverse-transcription polymerase chain reaction at postnatal ages of 2, 15, and 25 days. The role of Notch signaling in the proliferation and differentiation of osteoblasts isolated from calvarial was examined in vitro by EdU incorporation assays and real-time quantitative reverse-transcription polymerase chain reaction after activating and inhibiting Notch signaling. Results: The mRNA levels of Notch family members (including Jagged 1, Delta 1, 3, 4, Notch 1-4, Hes 1, and Hes 5) decreased during the posterofrontal cranial suture fusion in rat. However, in the patent sagittal sutures, the mRNA levels of Notch family members (Jagged 2, Delta 1, Notch 1, Notch 3, Hes 5, and Hey 1) increased during suture development. The EdU incorporation assays revealed that the induction of Notch signaling in calvaria osteobalsts using Jagged 1 promoted the proliferation rates in those cells in vitro. Further studies showed that activation of Notch signaling calvaria osteobalsts using Jagged 1 led to the suppression of late osteogenetic markers such as type I collagen and osteocalcin. Conclusions: The regulation of Notch signaling is of crucial importance during the physiological patterning of posterofrontal and sagittal cranial sutures. Thus, targeting this pathway may prove significant for the development of future therapeutic applications in craniosynostosis. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2uKnRby

Viability and Biomechanics of Diced Cartilage Blended With Platelet-Rich Plasma and Wrapped With Poly (Lactic-Co-Glycolic) Acid Membrane.

Objectives: The objective of this study was to investigate the viability and biomechanics of diced cartilage blended with platelet-rich plasma (PRP) and wrapped with poly (lactic-co-glycolic) acid (PLGA) membrane in a rabbit model. Methods: A total of 10 New Zealand rabbits were used for the study. Cartilage grafts were harvested from 1 side ear. The grafts were divided into 3 groups for comparison: bare diced cartilage, diced cartilage wrapped with PLGA membrane, and diced cartilage blended with PRP and wrapped with PLGA membrane. Platelet-rich plasma was prepared using 8 mL of auricular blood. Three subcutaneous pockets were made in the backs of the rabbits, and the grafts were placed in these pockets. The subcutaneous implant tests were conducted for safety assessment of the PLGA membrane in vivo. All of the rabbits were sacrificed at the end of 3 months, and the specimens were collected. The sections were stained with hematoxylin and eosin, toluidin blue, and collagen II immunohistochemical. Simultaneously, biomechanical properties of grafts were assessed. Results: This sample of PLGA membrane was conformed to the current standard of biological evaluation of medical devices. Moderate resorption was seen at the end of 3 months in the gross assessment in diced cartilage wrapped with PLGA membrane, while diced cartilage blended with PRP had no apparent resorption macroscopically and favorable viability in vivo after 3 months, and the histological parameters supported this. Stress-strain curves for the compression test indicated that the modulus of elasticity of bare diced cartilage was 7.65 +/- 0.59 MPa; diced cartilage wrapped with PLGA membrane was 5.98 +/- 0.45 MPa; and diced cartilage blended with PRP and wrapped with PLGA membrane was 7.48 +/- 0.55 MPa, respectively. Conclusions: Diced cartilage wrapped with PLGA membrane had moderate resorption macroscopically after 3 months. However, blending with PRP has beneficial effects in improving the viability of diced cartilages. Additionally, the compression modulus of diced cartilage blended with PRP and wrapped with PLGA membrane was similar to bare diced cartilage. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubgGw5

Application of Bidirectional Distraction Osteogenesis for the Treatment of Mandibular Micriognathia Caused by Temporomandibular Joint Ankylosis.

Background: Temporomandibular joint (TMJ) ankylosis is a joint disorder that refers to bone or fibrous adhesion of the anatomic joint components and the ensuing loss of function. When it happens on children, it is always accompanied by dentofacial deformities. The objective of this study was to describe the authors' experience of bidirectional distraction osteogenesis for the treatment of mandibular deformities caused by TMJ ankylosis. Methods: Sixteen patients with TMJ ankylosis and severe secondary mandibular deformities were treated with bidirectional distraction osteogenesis and release of joint from January 2013 to December 2015. Clinical outcomes were assessed based on the oral function, radiography, and medical photography. Results: No reankylosis was found during the follow-up period. Sufficient volume and density new bone had been formed after the consolidation period. All patients have maintained stable improvement in oral function during the follow-up period. Most of the patients achieved satisfactory outcomes. Conclusions: Bidirectional transport distraction osteogenesis technique is a good and effective therapeutic option in treatment of bilateral or unilateral TMJ ankylosis patients associated with mandibular micrognathia. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2uJT1Qr

Criteria for Performing Cranial Computed Tomography for Chinese Patients With Mild Traumatic Brain Injury: Canadian Computed Tomography Head Rule or New Orleans Criteria?.

Computed tomography (CT) provides the primary diagnostic evidence for traumatic brain injury (TBI), but few positive traumatic findings are discovered in patients with mild TBI. In China, there are no existing criteria for selecting patients with mild TBI to undergo CT, and almost all of these patients undergo cranial CT in the emergency department. This retrospective study was performed to evaluate the necessity of cranial CT among patients with mild TBI, as well as the feasibility of 2 popular criteria (Canadian CT head rule [CCHR] and New Orleans Criteria [NOC]) in China. Patients with mild TBI who underwent cranial CT within 24 hours of the trauma were included in our institute. Two neurosurgeons reviewed the CT images independently to identify positive CT findings. The sensitivity and specificity of CCHR and NOC for positive CT findings related to TBI were analyzed. Finally, this study included 625 patients. Positive CT findings related to TBI were discovered in 13.12% (82/625) of these patients on cranial CT, and 6.88% (43/625) of them were admitted to the hospital for further management. Ultimately, 11 patients (1.76%, 11/625) underwent neurosurgery. In this study, the sensitivities of both the CCHR and NOC were 100%, but the specificity of CCHR was 43.36% and that of NOC was 33.12%. Based on our study, both CCHR and NOC have high sensitivity for the detection of positive CT findings related to head trauma in patients with mild TBI. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2ubG6d9

Prophylaxis of postoperative complications after craniotomy.

Purpose of review: This review reports an update of the evidence on practices applied for the prevention and management of the most common complications after craniotomy surgery. Recent findings: Latest guidelines support the combined thromboprophylaxis with the use of both mechanical and chemical modalities, preferably applied within 24 h after craniotomy. Nevertheless, a heightened risk of minor hemorrhagic events remains an issue of concern. Postoperative nausea and vomiting (PONV) and pain constitute the complications most commonly encountered during the first 24 h postcraniotomy. Recently, neurokinin type-1 receptor antagonists have been tested as adjuncts for PONV prophylaxis with encouraging results, whereas dexmedetomidine and gabapentinoids emerge as promising alternatives for postcraniotomy pain management. The available data for seizure prophylaxis following craniotomy lacks scientific quality; thus, this remains still a debatable issue. Significantly, a growing body of evidence supports the superiority of levetiracetam over the older antiepileptic drugs (AEDs), in terms of efficacy and safety. Summary: Optimum management of postoperative complications is incorporated as an integral part of the augmented quality of care in patients undergoing craniotomy surgery, aiming to improve outcomes. This review may serve as a benchmark for neuroanesthetists for heightened clinical awareness and prompt institution of well-documented practices. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ub3AyR

Lipid emulsion in local anesthetic toxicity.

Purpose of review: Enthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local anesthetic systemic toxicity (LAST) remains. Intravenous lipid emulsion (ILE) for the treatment of LAST has been endorsed by anesthetic regulatory societies on the basis of animal study and human case report data. The accumulated mass of reporting now permits objective interrogation of published literature. Recent findings: Although incompletely elucidated the mechanism of action for ILE in LAST seemingly involves beneficial effects on initial drug distribution (i.e., pharmacokinetic effects) and positive cardiotonic and vasoactive effects (i.e., pharmacokinetic effects) acting in concert. Recent systematic review by collaborating international toxicologic societies have provided reserved endorsement for ILE in bupivacaine-induced toxicity, weak support for ILE use in toxicity from other local anesthetics, and largely neutral recommendation for all other drug poisonings. Work since publication of these recommendations has concluded that there is a positive effect on survival for ILE when animal models of LAST are meta-analyzed and evidence of a positive pharmacokinetic effect for lipid in human models of LAST. Summary: Lipid emulsion remains first-line therapy (in conjunction with standard resuscitative measures) in LAST. Increasing conjecture as to the clinical efficacy of ILE in LAST, however, calls for high-quality human data to refine clinical recommendations. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uKlCVV

Effects of Interleukin 17 on the cardiovascular system

Publication date: Available online 10 July 2017
Source:Autoimmunity Reviews
Author(s): Marie Robert, Pierre Miossec
Cardiovascular diseases remain the leading cause of death worldwide and account for most of the premature mortality observed in chronic inflammatory diseases. Common mechanisms underlie these two types of disorders, where the contribution of Interleukin (IL)-17A, the founding member of the IL-17 family, is highly suspected. While the local effects of IL-17A in inflammatory disorders have been well described, those on the cardiovascular system remain less studied. This review focuses on the effects of IL-17 on the cardiovascular system both on isolated cells and in vivo. IL-17A acts on vessel and cardiac cells, leading to inflammation, coagulation and thrombosis. In vivo and clinical studies have shown its involvement in the pathogenesis of cardiovascular diseases including atherosclerosis and myocardial infarction that occur prematurely in chronic inflammatory disorders. As new therapeutic approaches are targeting the IL-17 pathway, this review should help to better understand their positive and negative outcomes on the cardio-vascular system.



http://ift.tt/2t6YApV

Biologics in Myelodysplastic Syndrome-related Systemic Inflammatory and Autoimmune Diseases: French Multicenter Retrospective Study of 29 Patients

Publication date: Available online 10 July 2017
Source:Autoimmunity Reviews
Author(s): Arsene Mekinian, Guillaume Dervin, Nathanael Lapidus, Jean-Emmanuel Kahn, Louis Terriou, Eric Liozon, Eric Grignano, Jean-Charles Piette, Odile Beyne Rauzy, Vincent Grobost, Pascal Godmer, Jerome Gillard, Julien Rossignol, David Launay, Achille Aouba, Thierry Cardon, Laurence Bouillet, Jonathan Broner, Julien Vinit, Lionel Ades, Fabrice Carrat, Clementine Salvado, Eric Toussirot, Mathilde Versini, Nathalie Costedoat-Chalumeau, Jean Baptiste Fraison, Philippe Guilpain, Pierre Fenaux, Olivier Fain
BackgroundSystemic inflammatory and autoimmune diseases (SIADs) associated with myelodysplastic syndromes are often difficult to treat. Corticosteroids are efficient but only usually at high doses. The use of biologics needs to be specified.MethodsIn a French multicenter retrospective study, we analyzed the efficacy and safety of biologics (tumor necrosis factor-α [TNF-α] antagonists, tocilizumab, rituximab and anakinra) for SIADs associated with myelodysplastic syndromes (MDSs). Clinical, biological and overall treatment responses were evaluated. When several lines of treatment were used, data were analyzed before and at the end of each treatment line and were pooled to compare overall response among steroids, disease-modifying anti-rheumatic drugs (DMARDs) and biologics.ResultsWe included 29 patients (median age 67years [interquartile range 62–76], 83% males) with MDS-related SIADs treated with at least one biologic. The MDSs were predominantly refractory anemia with excess blasts 1 (38%) and refractory cytopenia with multilineage dysplasia (21%). The SIADs were mainly arthritis (n=6; 20%), relapsing polychondritis (n=8; 30%) and vasculitis (n=10; 34%). During a 3-year median follow-up (IQR 1.3–4.5), a total of 114 lines of treatments were used for all patients: steroids alone (22%), DMARDs (23%), TNF-α antagonists (14%), anakinra (10%), rituximab (10%), tocilizumab (7%) and azacytidine (9%). Considering all 114 lines, overall response (complete and partial was showed in 54% cases. Overall response was more frequent with steroids (78%) and rituximab (66%) than DMARDs (45%) and other biologics (33%) (p<0.05). Rituximab had better response in vasculitis and TNF-α antagonists in arthritis. During follow-up, 20 patients (71%) presented at least one severe infection.ConclusionThis nationwide study demonstrates the efficacy of steroids for SIAD-associated MDSs but a high frequency of steroid dependence. The response to biologics seems low, but rituximab and azacytidine seem promising.



http://ift.tt/2tB8kfw

Otolaryngology exposure in a longitudinal integrated clerkship setting

Although 20–40% of primary care complaints are Otolaryngology-Head and Neck Surgery (OtoHNS) related, little emphasis is placed on OtoHNS instruction at the undergraduate medical education level. An OtoHNS cle...

http://ift.tt/2sIESBs

Theranostik

Zusammenfassung

Hintergrund

Die erfolgreiche Behandlung von neuroendokrinen Tumoren nach dem Theranostik-Prinzip ist ein Durchbruch, der auch andere Tumorentitäten in den Fokus der molekularen Bildgebung und Therapie mit radiosiotopenmarkierten Liganden gerückt hat.

Ergebnisse

Der Nachweis von primären und metastasierten Prostatakarzinomen mit Gallium-68(⁶⁸Ga)-markiertem PSMA („prostate-specific membrane antigen") und die molekulare Radiotherapie mit Lutetium-177(¹⁷⁷Lu)-PSMA unter Verwendung sog. kleiner Moleküle in Form der PSMA-vermittelten Radioligandentherapie (PRLT) gilt als nächster Meilenstein der personalisierten nuklearmedizinischen Diagnostik und Therapie. Die ⁶⁸Ga-PSMA-PET-CT ermöglicht den spezifischen Nachweis von primären Prostatakarzinomen und die Detektion sehr kleiner Metastasen im Bereich von wenigen Millimetern mit bisher nicht gekannter Sensitivität und Spezifität. Die quantitativen PET-CT-Bilddatensätze dienen auch der gezielten Selektion von Patienten für die PRLT im Sinne der „precision medicine" und können ebenso für die Evaluation des Ansprechens auf die Therapie (molekulare Therapieantwort) herangezogen werden.

Schlussfolgerung

Die Ergebnisse der seit Frühjahr 2013 mit ¹⁷⁷Lu-PSMA behandelten Patienten in verschiedenen deutschen Zentren zeigen, dass die PRLT ein sehr großes Potenzial zur effektiven Therapie von Patienten mit metastasierten Prostatakarzinomen hat, die auf eine Hormon- und/oder Chemotherapie nicht mehr ansprechen. Weitere, möglichst prospektive und randomisierte Studien zur validen Ermittlung von Daten zum progressionsfreien und zum Gesamtüberleben müssen den Stellenwert der Radioligandentherapie mit ¹⁷⁷Lu-PSMA und den evtl. früheren Einsatz und die Abfolge im Rahmen verschiedener Therapiemodalitäten zukünftig noch genauer definieren, insbesondere im Vergleich (oder auch in Kombination) mit bereits etablierten Substanzen wie Enzalutamid, Abirateron oder Docetaxel. Weitere Verbesserungen sind durch die Anwendung von α‑Strahlern (z. B. Actinium-225- oder Bismuth-213-markierte PSMA-Liganden) sowie die Kombination mit Hormonsyntheseinhibitoren oder mit Radiosensitizern denkbar.

http://ift.tt/2uJ4xeQ

Otolaryngology exposure in a longitudinal integrated clerkship setting

Abstract

Background

Although 20–40% of primary care complaints are Otolaryngology-Head and Neck Surgery (OtoHNS) related, little emphasis is placed on OtoHNS instruction at the undergraduate medical education level. An OtoHNS clerkship rotation is not required at most Canadian medical schools. Furthermore, at institutions offering an OtoHNS rotation, less than 20% of students are able to complete a placement. Given that a large percentage of medical students in Canada will pursue primary care as a career, there remains a gap in providing OtoHNS clinical training. During the longitudinal integrated clerkship at the Northern Ontario School of Medicine (NOSM), students are assigned to one of 14 sites, and not all have access to an otolaryngologist. This study looks to quantify the level of exposure students are receiving in OtoHNS at NOSM and to assess their comfort level with diagnosing and treating common otolaryngologic conditions.

Methods

A structured 13-item survey was administered to second, third and fourth year medical students at NOSM.

Results

A majority (67.9%) of medical students surveyed had not observed an otolaryngologist. Furthermore, most students (90.6%) reported receiving very little OtoHNS classroom based and clinical instruction during medical school.

Conclusions

A discrepancy exists between the quantity and breadth of OtoHNS training received in undergraduate medical education and the volume of OtoHNS encounters in primary care practice. Although geographic dissemination of students in the distributed learning model may be a challenge, strategies such as standardized objectives and supplemental electronic resources may serve to solidify clinical knowledge.

http://ift.tt/2sX7lYn

Taking Care of Vulnerable Populations as Global Health – Case Reports on Refugees and Migrants

By Nathan Douthit

According to the United Nations High Commissioner for Refugees, a refugee is someone who," owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country ." ¹ Globally, the World Health Organization estimates there are 65 million forcibly displaced persons, 86% of whom are in developing countries .²  Implicit in the care of refugees are complex healthcare challenges including language barriers, unfamiliarity with the theory and practice of primary health care, common exposure to violence, torture and warfare, the high prevalence of PTSD, anxiety and depression and anti-immigrant sentiment in their new host country. Access to primary care is an essential facet of refugee care. Low socio-economic status and social isolation complicates the management of chronic non-communicable disease.

 

In the case report  "A Rohingya refugee's journey in Australia and the barriers to accessing healthcare," Jiwrajka et al discuss some of these issues.³ The case describes the peculiar challenge of the Rohingya people

 

"[o]ver 200000 Rohingya refugees are currently resettled in Bangladesh, a country with already limited health-care for its own citizens as well as a non-signatory country to any of the United Nations Refugee or Stateless Conventions. As a result, refugees are not guaranteed access to basic human rights, including healthcare."

 

Even with a robust translation service freely available in Australia, this patient states the interpreter spoke an "unfamiliar dialect." She did not understand her prescriptions as a result.  The patient did not feel that her doctors cared about her concerns of infertility, instead she states that "the doctors were more interested in her diabetes." The low socio-economic status of this patient is linked to her health – the authors write:

 

"[T]here is a disproportionate burden of diabetes among minority groups, migrants and the socioeconomically vulnerable. [Socioeconomic status] and social stratification are intrinsically linked to health, in turn creating a social gradient of health. As a result, adverse health outcomes within vulnerable populations, including refugees, transgress beyond the individual to affect whole communities."

 

Due to a variety of factors, most notably the conflict in Syria, the world is in the midst of the largest migration of people since World War II. BMJ Case Reports invites authors to publish cases regarding the health of these vulnerable patients as well as the dilemmas created by migration on national health systems. Global health case reports can emphasize:

-Barriers to access of care due to linguistic, social and cultural differences

-Problems created by lack of cultural competence in healthcare systems

-Discrimination and effects on healthcare for refugees and migrants

-Uncontrolled chronic conditions due to migration or delays in access to healthcare

-Other factors that exacerbate the vulnerability of migrant populations

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about refugee health at BMJCR:

–Paired suicide in a young refugee couple on the Thai-Myanmar border

–A Syrian man with abdominal pain

–Ethiopian-Israeli community

References:

1. UNHCR. Global Strategy for Public Health: A UNHCR Strategy 2014-2018. United Nations High Commission for Refugees, Geneva. 2014.
2. WHO. Refugee and migrant health [internet]. World Health Organization 2017 [cited July 6 2017] Available at: http://ift.tt/2uIs27X
3. A Rohingya refugee's journey in Australia and the barriers to accessing healthcare. Manasi Jiwrajka, Ahmad Mahmoud, Maneeta Uppal. BMJ Case Reports 2017: published online 9 May 2017, doi:10.1136/bcr-2017-219674.

Selected References on Refugee and Migrant Health from other sources:

-Hunter P. The refugee crisis challenges national health care systems. EMBO reports. 2016 Apr 1;17(4):492-5.

-Onnell C. Healthcare for Syrian refugees. BMJ. 2015 Aug 8:13.

-Jackson JC, Haider M, Owens CW et al. Healthcare Recommendations For Recently Arrived Refugees: Observations from EthnoMed. Harvard Public Health Review. 2016 April;7

 

 

 

http://ift.tt/2u9WTxa

“Tumor immunology meets oncology (TIMO) XII”, April 28th–30th 2016, Halle/Saale, Germany

http://ift.tt/2tFIfKI

Hereditary leiomyomatosis and renal cell cancer syndrome: A novel mutation in the FH gene

http://ift.tt/2sH2Q08

Infectious urticaria complicated with intestinal edema

http://ift.tt/2tZuycg

Grundlage der Behandlung ekzematöser Erkrankungen im HNO-Bereich

Zusammenfassung

Zellvermittelte Immunantworten sind Typ-IV-Reaktionen nach Coombs und Gell und werden v. a. durch T‑Lymphozyten getragen. Die auslösenden Allergene sind in aller Regel sog. Haptene, also Stoffe, die erst durch Bindung an Proteinträgersubstanzen zu Vollantigenen werden. Allergische Spättypreaktionen imponieren im HNO-Bereich überwiegend als Kontaktekzeme, oft als Gesichtsdermatitis, Ohrmuschel- und Gehörgangsekzem und periorale Ekzeme. Anamnese und Morphologie eines Ekzems sind diagnostisch wegweisend. Die Verifizierung erfolgt mittels Epikutantest nach den Leitlinien der AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften). Hierbei werden die häufigsten Kontaktallergene im „Standardblock" getestet, den man anamnesebezogen auf ein individualisiertes Allergenspektrum reduzieren kann. In der Therapie ist die wichtigste Maßnahme die Allergenkarenz, die auch prophylaktisch eingesetzt werden sollte. Darüber hinaus wird das Kontaktekzem antiinflammatorisch ausschleichend mit einem topischen Kortikosteroid behandelt. Je nach Alter, Lokalisation und Schweregrad des Kontaktekzems ist hier ein neueres Klasse-II- oder -III-Präparat zu wählen. Pflegepräparate helfen dabei, Kortikosteroide einzusparen und sind nach der akuten Phase zusätzlich indiziert. Eine wichtige Differenzialdiagnose des Kontaktekzems ist die atopische Dermatitis. Während das Kontaktekzem durch Meiden der auslösenden Noxe eine Abheilung erfährt, zeigt die genetisch determinierte atopische Dermatitis einen chronisch-rezidivierenden Verlauf. Zusätzlich zu den topischen Kortikosteroiden sind auch Calcineurin-Inhibitoren zur Therapie des atopischen Ekzems zugelassen. Bei allen Ekzemerkrankungen ist die regelmäßige Pflege eine notwendige Maßnahme, die v. a. zur Barrierereparatur beiträgt.

http://ift.tt/2u4Im4Z

Phasen, Störungen und Förderung der Wundheilung

Zusammenfassung

Durch Verletzung der Haut setzt die Wundheilung ein, welche durch Interaktion verschiedener Zellen und Ausschüttung diverser pro- und antiinflammatorischer Mediatoren in 3 aufeinanderfolgenden, teils überlappenden Phasen zur primären oder sekundären Defektheilung führt. Verschiedene lokale und systemische Faktoren können das fein aufeinander abgestimmte Gleichgewicht zwischen Auf- und Abbau stören und die einzelnen Phasen verzögern oder gar zum Stillstand bringen, sodass eine chronische Wunde oder eine fehlerhafte Heilung resultiert. Hier gilt es, die verschiedenen zur Verfügung stehenden chirurgischen und nichtchirurgischen Maßnahmen einzusetzen, um eine gestörte Wundheilung in die physiologische Abheilung zu überführen und die Integrität der Schutzschicht wiederherzustellen, damit der Organismus vor äußerlichen Schädigungen bewahrt wird.

http://ift.tt/2v2R80l

Histiocytic and dendritic cell neoplasms: what have we learnt by studying 67 cases

Abstract

Tumors derived from histiocytic and dendritic cells encompass a large and heterogeneous group of neoplastic and reactive conditions, and their diagnosis is challenging both for pathologists and clinicians. Diagnosis is based on morphological and phenotypical findings, but hybrid features are not uncommon. Furthermore, recent studies uncovered the molecular mechanisms driving some of these tumors, improving diagnostic adequacy, and providing the basis for effective therapeutic breakthroughs.

Sixty-seven cases were submitted to the accessory cell and histiocytic neoplasms session at the European Association of Haematopathology/Society for Hematopathology workshop 2016 held in Basel, Switzerland. The cases included histiocytic sarcomas (HS), Langerhans cell tumors (LCT), Erdheim-Chester disease, interdigitating dendritic cell sarcomas (IDCS), indeterminate dendritic cell tumors (IND-DCT), follicular dendritic cell sarcomas, and blastic plasmacytoid dendritic cell neoplasms. Rosai-Dorfman disease and, more rare, conditions such as ALK-positive histiocytosis were also submitted. These cases illustrated classical and unexpected features at morphological, phenotypical, and molecular levels, providing a valuable compendium for pathologists confronting with these tumors.

The paper summarizes the most notable features of every single group of diseases, with comments about the most challenging issues, in the attempt to provide practical indications for their recognition.

http://ift.tt/2sWoZf1

Circulating myeloid-derived suppressor cells increase in patients undergoing neo-adjuvant chemotherapy for breast cancer

Abstract

This study sought to evaluate whether myeloid-derived suppressor cells (MDSC) could be affected by chemotherapy and correlate with pathologic complete response (pCR) in breast cancer patients receiving neo-adjuvant chemotherapy. Peripheral blood levels of granulocytic (G-MDSC) and monocytic (M-MDSC) MDSC were measured by flow cytometry prior to cycle 1 and 2 of doxorubicin and cyclophosphamide and 1st and last administration of paclitaxel or paclitaxel/anti-HER2 therapy. Of 24 patients, 11, 6 and 7 patients were triple negative, HER2+ and hormone receptor+, respectively. 45.8% had pCR. Mean M-MDSC% were <1. Mean G-MDSC% and 95% confidence intervals were 0.88 (0.23–1.54), 5.07 (2.45–7.69), 9.32 (4.02–14.61) and 1.97 (0.53–3.41) at draws 1–4. The increase in G-MDSC by draw 3 was significant (p < 0.0001) in all breast cancer types. G-MDSC levels at the last draw were numerically lower in patients with pCR (1.15; 95% CI 0.14–2.16) versus patients with no pCR (2.71; 95% CI 0–5.47). There was no significant rise in G-MDSC from draw 1 to 3 in African American patients, and at draw 3 G-MDSC levels were significantly lower in African Americans versus Caucasians (p < 0.05). It was concluded that G-MDSC% increased during doxorubicin and cyclophosphamide therapy, but did not significantly differ between patients based on pathologic complete response.

http://ift.tt/2sGJgRB

First Report on Fetal Cerebral Polyglucosan Bodies in Mucopolysaccharidosis Type VII

We report on the detection of discordant inclusions in the brain of a 25-week female fetus with a very rare lysosomal storage disease, namely, Sly disease (mucopolysaccharidosis (MPS) type VII), presenting with nonimmune hydrops fetalis. Besides vacuolated neurons, we found abundant deposition of polyglucosan bodies (PGBs) in the developing brain of this fetus in whom MPS-VII was corroborated by lysosomal beta-glucuronidase-deficiency detected in fetal blood and fetal skin-fibroblasts and by the presence of a heterozygous pathogenic variant in the GUSB gene in the mother. Fetal/neonatal metabolic disorders with PGB-deposition are extremely rare (particularly in relation to CNS involvement) and include almost exclusively subtypes of glycogenosis (types IV and VII). The accumulation of PGBs (particularly in the fetal brain) has so far not been depicted in Sly disease. This is the first report on such "aberrant" association. Besides, the detection of these CNS inclusions at such an early developmental stage is remarkably unique.

http://ift.tt/2u3EJML

Surgical specimen handover from the operating theatre to laboratory - can we improve patient safety by learning from aviation and other high-risk organisations?

Abstract

Essential communication between healthcare staff is considered one of the key requirements for both safety and quality care when patients are handed over from one clinical area to other. This is particularly important in environments such as the operating theatre and intensive care where mistakes can be devastating. Healthcare has learned from other high-risk organisations (HRO) such aviation where the use of checklists and human factors awareness has virtually eliminated human error and mistakes. To our knowledge, little has been published around ways to improve pathology specimen handover following surgery, with pathology request forms often conveying the bare minimum of information to assist the laboratory staff. Furthermore, the request form might not warn staff about potential hazards.

In this article, we provide a brief summary of the factors involved in human error and introduce a novel checklist that can be readily completed at the same time as the routine pathology request form. This additional measure enhances safety, can help to reduce processing and mislabelling errors and provides essential information in a structured way assisting both laboratory staff and pathologists when handling head and neck surgical specimens.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tETwLr

Topical treatment with sacran, a sulfated polysaccharide from Aphanothece sacrum, improves corneocyte-derived parameters

Abstract

Sacran, a polysaccharide isolated from Aphanothece sacrum (Suizenji-nori) alga, has unique characteristics in terms of its physiological properties and effects on the skin, and has recently become a focus of attention as a novel biomaterial. In a previous study, we reported the unique physical characteristics of sacran, which forms a gel-like film containing water in the presence of polyols. This film resists penetration by water and chemicals. We expected this unique physical characteristic to act as an artificial barrier upon the application of sacran to the skin. In the present study, we tested the efficacy of sacran application in healthy individuals who reported previous symptoms of dry or inflamed skin, to evaluate the potential benefits of sacran for skin care in patients with mild atopic dermatitis. Compared with placebo, sacran-containing serum did not significantly alter either the water content of the skin surface or transepidermal water loss. However, subjects using the serum showed improvements in corneocyte parameters including size, percentage of thick abrasion, ratio of SH to SS groups, ratio of interleukin (IL)-1 receptor antagonist to IL-1α, and carbonylated protein level. These results indicate that the sulfated polysaccharide sacran is an effective agent for improving or maintaining the skin conditions.

http://ift.tt/2sWa44t

Adult-onset Still's disease-like condition due to alcoholic hepatitis and vitamin B deficiency

http://ift.tt/2tETGT3

Successful treatment of continuous intra-arterial administration of prostaglandin E1, urokinase and heparin for intractable digital ulcers by upper extremity arterial occlusion in diffuse cutaneous systemic sclerosis patient

http://ift.tt/2sWmlpt

Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients

Abstract

Psoriatic arthritis (PsA) is a spondyloarthritic condition mainly seen in patients with psoriasis. Psoriatic patients with plaques on the scalp, gluteal fold or nail lesions are known to develop PsA more frequently, but other markers for PsA have not yet been identified. To determine which psoriatic patients are at greatest risk of developing PsA, psoriasis vulgaris (PsV) patients who visited the Department of Dermatology, Fukuoka University Hospital in 2015 were enrolled. Patients with and without PsA were statistically compared with respect to age, sex, age at onset, body mass index (BMI), smoking and drinking habits, familial history of psoriasis and comorbidities. Of 331 patients (237 men, 94 women), 55 had PsA (17%; 39 men, 16 women). PsA patients had significantly higher frequencies of nail lesions (PsA vs PsV-only, 62% vs 29%; P < 0.0001) and hyperuricemia (PsA vs PsV-only, 22% vs 9%; P = 0.01). These were confirmed as independent risk factors for PsA by logistic regression analysis, with odds ratios of 5.05 for nail lesions (P < 0.0001) and 4.18 for hyperuricemia (P < 0.01). There was no difference in age at onset, sex, BMI and incidence of diabetes mellitus, hypertension or dyslipidemia. Hyperuricemia is also known to be more frequent in psoriatic subjects than the normal population. Uric acid crystals are a strong stimulator of innate immunity. Considering that none of our cohort had gouty arthritis, hyperuricemia may increase uric acid crystallization in and around joints, thereby inducing PsA in psoriatic subjects. Hyperuricemia appears to be an independent risk factor for PsA.

http://ift.tt/2tFBDvZ

Editorial Board

http://ift.tt/2sFPj8P

Table of Contents

http://ift.tt/2tZhXG4

Letter of response to Greenhawt et al. ‘LEAPing Through the Looking Glass: Secondary Analysis of the Effect of Skin Test Size and Age of Introduction on Peanut Tolerance after Early Peanut Introduction’

http://ift.tt/2sFzOOo

Impact of human papillomavirus on outcome in patients with oropharyngeal cancer treated with primary surgery

Abstract

Background

Knowledge about prognostic factors in surgically treated patients with oropharyngeal squamous cell carcinoma (SCC) is limited. The purpose of this study was to identify influential factors on survival in a large cohort of patients with surgically treated oropharyngeal SCC.

Methods

Retrospective analysis of survival estimates in patients with surgically treated oropharyngeal SCC using tumoral positivity for human papillomavirus (HPV) and risk-of-death categories according to a study from 2010 as stratification factors.

Results

The 5-year overall survival (OS) and disease-specific survival (DSS) rates after surgery alone were higher in HPV-associated oropharyngeal SCC (OS 80% vs 62%; P = .01; DSS 92% vs 76%; P = .03). Patients in the low-risk category had higher survival rates (OS 91%; DSS 99%) than patients in the intermediate-risk group (OS 63%; DSS 83%), and high-risk group (OS 61%; DSS 75%).

Conclusion

Nonsmokers with HPV-positive oropharyngeal SCC have a better prognosis than smokers with HPV-positive oropharyngeal SCC and also than patients with HPV-negative tumors when treated by surgery alone.

http://ift.tt/2v1UlgQ

Survival benefit of surgical approach for advanced oropharyngeal and hypopharyngeal cancer: A retrospective analysis

Abstract

Background

Head and neck cancer is increasingly being managed through nonsurgical approaches. Evidence comes from studies that have mainly examined patients with laryngeal cancer. Few studies, with limited sample size, have focused on the comparative outcomes of surgical and nonsurgical approaches in patients with advanced oropharyngeal or hypopharyngeal cancer.

Methods

Using a national cancer database, we identified 1603 and 1512 patients with clinical stage III/IVA oropharyngeal and hypopharyngeal cancer, respectively, treated between 2004 and 2009. The study cohort was followed until 2012, and analyzed through Kaplan-Meier survival analysis and Cox regression.

Results

Overall, 31.4% of patients with advanced oropharyngeal cancer and 42.2% of patients with hypopharyngeal cancer received surgery as their primary treatment. Receiving primary surgery for advanced oropharyngeal and hypopharyngeal cancer was associated with higher survival rates after controlling for potential confounders.

Conclusion

We recommend that surgery be considered a first-line treatment for advanced oropharyngeal and hypopharyngeal cancers.

http://ift.tt/2u35EIu

Feasibility of a wait-and-scan period as initial management strategy for head and neck paraganglioma

Abstract

Background

The main goal of head and neck paraganglioma (PGL) management is reduction of treatment-induced and tumor-induced complications. In the current study, tumor growth rates and tumor-induced complications during a wait-and-scan period are evaluated.

Methods

This was a retrospective cohort study. Tumor growth was measured in axial plane diameter and tumor volume.

Results

Of 59 jugulotympanic tumors, 71 carotid body tumors, and 29 vagal body tumors, 44% were growing (median follow-up of 63.6 months). Median growth rates were 0.41 mm/year (range 0–439 mm), 1.6 mm/year (range 0–23.68 mm), and 1.6 mm/year (range 0–23.68 mm) respectively. Growth was significantly correlated to age at presentation (odds ratio [OR] = 0.974; P < .05). Seventeen tumors induced 20 complications. Six of these tumors were growing, and growth rates were higher than in tumors not inducing complications (P = .016; F = 6.496).

Conclusion

These results illustrate the feasibility of a wait-and-scan strategy for head and neck PGL. The management strategy could not prevent tumor-induced complications in 16% of nongrowing tumors.

http://ift.tt/2v1zo5u

Unilateral linear basaloid follicular hamartoma: Its diagnosis and successful treatment with surgical excision and adjuvant dermabrasion

http://ift.tt/2tydglE

Trigeminal trophic syndrome: Analysis of the number of peripheral nerve fibres and blood vessels in the lesional skin

http://ift.tt/2tER6MF

Cutaneous infiltration of anaplastic variant of CD30-positive diffuse large B-cell lymphoma

http://ift.tt/2sVupae

Acute localised exanthematous pustulosis secondary to pembrolizumab

http://ift.tt/2tEWxeC

A rare cause of alopecia: Lipedematous alopecia

http://ift.tt/2tER6fD

A case of post-partum non-sexually acquired genital ulceration

http://ift.tt/2sVmREk

Spot diagnosis: Progressive cribriform and zosteriform hyperpigmentation

http://ift.tt/2tFdfdS